Bronchoscopy: Procedure, Preparation & Recovery

What Is Bronchoscopy?

Bronchoscopy is a minimally invasive procedure that allows doctors to visualize the inside of your airways (trachea and bronchi) and lungs using a specialized instrument called a bronchoscope. This thin, tube-like device has a camera and light that transmit real-time images to a video monitor.

Bronchoscopy has become one of the most important diagnostic tools in pulmonary medicine since its development in the late 19th century. Today's modern bronchoscopes are equipped with high-definition cameras, working channels for instruments, and sophisticated imaging capabilities that allow physicians to examine even the smallest airways with remarkable clarity.

The procedure serves both diagnostic and therapeutic purposes. Diagnostically, it helps identify the cause of unexplained symptoms such as chronic cough, hemoptysis (coughing up blood), or abnormal findings on chest imaging. Therapeutically, bronchoscopy can be used to remove foreign objects, clear mucus plugs, place stents, and deliver treatments directly to affected areas of the lungs.

There are two main types of bronchoscopes used in clinical practice: flexible bronchoscopes and rigid bronchoscopes. Each has specific indications and advantages depending on the clinical situation. Understanding the differences between these instruments helps patients know what to expect from their procedure.

Flexible Bronchoscopy

A flexible bronchoscope is a thin, pliable tube typically about 5-6 millimeters in diameter. Its flexibility allows it to navigate through the curves of the airways, reaching smaller bronchi that would be inaccessible with rigid instruments. Most diagnostic bronchoscopies today are performed with flexible bronchoscopes.

The flexible bronchoscope contains fiber-optic bundles or a digital camera chip at its tip, along with channels for suctioning secretions, delivering saline for washing (lavage), and passing instruments for biopsies. Adults undergoing flexible bronchoscopy typically receive local anesthesia (numbing spray) and conscious sedation, remaining awake but relaxed throughout the procedure.

Rigid Bronchoscopy

A rigid bronchoscope is a straight, hollow metal tube that provides a larger working channel than flexible instruments. This type of bronchoscope is preferred for certain therapeutic interventions such as removing large foreign objects, controlling massive bleeding, or placing airway stents. Rigid bronchoscopy always requires general anesthesia.

Because rigid bronchoscopy requires general anesthesia and specialized expertise, it is typically performed in operating room settings by interventional pulmonologists or thoracic surgeons. The larger working channel allows the use of more substantial instruments and provides better access for procedures requiring direct intervention in the central airways.

Why Is Bronchoscopy Done?

Bronchoscopy is performed to diagnose lung conditions including cancer, infections, and inflammatory diseases. It can also be used therapeutically to remove foreign objects from the airways, clear mucus blockages, or take tissue samples (biopsies) for laboratory analysis.

Physicians recommend bronchoscopy when they need detailed information about the airways and lungs that cannot be obtained through less invasive methods. The procedure provides direct visualization of the bronchial tree and allows for sampling of tissues and secretions that would otherwise be inaccessible.

The decision to perform bronchoscopy is based on careful consideration of the patient's symptoms, imaging findings (such as chest X-rays or CT scans), and clinical history. In many cases, bronchoscopy provides definitive answers that guide treatment decisions and help avoid more invasive procedures like surgery.

Diagnostic Indications

Bronchoscopy serves as a primary diagnostic tool for numerous pulmonary conditions. Unexplained symptoms that persist despite initial treatment often warrant bronchoscopic evaluation. These include chronic cough lasting more than 8 weeks, hemoptysis (coughing up blood), unexplained wheezing or stridor (abnormal breathing sounds), and recurrent or non-resolving pneumonia.

Abnormal findings on chest imaging are another common indication. When CT scans or X-rays reveal lung masses, nodules, mediastinal lymphadenopathy (enlarged lymph nodes), or unexplained infiltrates, bronchoscopy can help determine the underlying cause. Direct visualization and tissue sampling allow pathologists to examine cells under the microscope and identify cancers, infections, or inflammatory conditions.

• Lung cancer evaluation: Bronchoscopy is essential for diagnosing and staging lung cancer, allowing physicians to visualize tumors and obtain tissue samples for determining cancer type
• Infectious disease diagnosis: The procedure helps diagnose tuberculosis, fungal infections, and pneumonia in immunocompromised patients when sputum samples are not diagnostic
• Interstitial lung disease: Bronchoalveolar lavage during bronchoscopy helps characterize inflammatory patterns in conditions like sarcoidosis and hypersensitivity pneumonitis
• Airway abnormalities: Bronchoscopy can identify structural problems such as tracheal stenosis (narrowing), tumors obstructing airways, or damage from trauma or intubation

Therapeutic Uses

Beyond diagnosis, bronchoscopy serves important therapeutic functions. Foreign body removal is one of the most critical applications, particularly in children who may have aspirated small objects like beads, nuts, or toy parts. The bronchoscope allows direct visualization and extraction of these objects before they cause airway obstruction or infection.

Other therapeutic applications include clearing thick mucus plugs that block airways (particularly in patients with cystic fibrosis or those on mechanical ventilation), placing stents to keep narrowed airways open, delivering medications directly to affected lung tissue, and performing laser therapy or cryotherapy to treat tumors obstructing the airways.

How Should You Prepare for a Bronchoscopy?

Preparation for bronchoscopy includes fasting for 4-6 hours before the procedure, informing your doctor about all medications (especially blood thinners), having blood tests done beforehand, and removing nail polish or artificial nails. You will also need to arrange transportation home since you cannot drive after sedation.

Proper preparation is essential for a safe and successful bronchoscopy. Your medical team will provide specific instructions based on your individual health situation, but there are general guidelines that apply to most patients. Following these instructions carefully helps minimize risks and ensures the procedure can proceed as planned.

The preparation process typically begins days or weeks before the scheduled procedure. Your physician will review your medical history, current medications, and any previous anesthesia experiences. This information helps the team anticipate potential complications and plan appropriately for your specific needs.

Fasting Requirements

You must not eat or drink anything for 4-6 hours before your bronchoscopy. The exact duration may vary between medical facilities, so follow your specific instructions carefully. This fasting period is crucial because sedation can suppress your gag and cough reflexes, increasing the risk of aspiration (inhaling stomach contents into your lungs).

In addition to food and beverages, you should avoid smoking and using chewing tobacco or nicotine products during the fasting period. These substances can increase secretions and affect your response to anesthesia. If you are taking medications that must be taken on the morning of the procedure, ask your doctor whether you can take them with a small sip of water.

Medication Adjustments

Blood-thinning medications require special attention before bronchoscopy. If you take anticoagulants such as warfarin, rivaroxaban, apixaban, or dabigatran, or antiplatelet drugs like clopidogrel, inform your physician at least one week before the procedure. These medications may need to be stopped or adjusted to reduce bleeding risk during biopsies.

Your doctor will weigh the risks of stopping blood thinners against the risks of bleeding during the procedure. In some cases, alternative medications or bridging therapy may be recommended. Never stop taking prescribed blood thinners without explicit guidance from your healthcare provider, as this could increase your risk of blood clots.

• Tell your doctor about: All prescription and over-the-counter medications, herbal supplements, and vitamins you take
• Blood tests: Your doctor may order blood work to check clotting function and blood counts before the procedure
• Heart evaluation: Depending on your health history, you may need an electrocardiogram (ECG) or other cardiac assessment
• Remove nail polish: Nail polish and artificial nails should be removed so the pulse oximeter can accurately monitor your oxygen levels
• Comfortable clothing: Wear loose, comfortable clothing; you will change into a hospital gown for the procedure

What Happens During a Bronchoscopy?

During bronchoscopy, you lie on an examination table while the doctor inserts a thin bronchoscope through your nose or mouth into your airways. Local anesthesia numbs your throat, and sedation helps you relax. The doctor examines your airways on a video monitor and may take tissue samples. The procedure typically takes 20-30 minutes.

Understanding what happens during a bronchoscopy can help reduce anxiety about the procedure. While it may seem intimidating, millions of bronchoscopies are performed safely each year. The medical team is experienced in ensuring patient comfort throughout the examination.

When you arrive for your bronchoscopy, you will check in and complete any remaining paperwork. A nurse will verify your identity, confirm your fasting status, and review your medical history. You will change into a hospital gown and have an intravenous (IV) line placed in your arm or hand for administering fluids and medications.

Before the Bronchoscope Is Inserted

Once in the procedure room, you will lie on your back on a comfortable examination table. The medical team will attach monitoring equipment including a blood pressure cuff, electrocardiogram leads, and a pulse oximeter on your finger to continuously track your vital signs throughout the procedure.

The physician or nurse will administer a local anesthetic spray to your nose and throat. This numbing medication reduces your gag and cough reflexes, making the passage of the bronchoscope more comfortable. The spray may taste bitter, but the sensation fades quickly as the anesthesia takes effect.

Sedation is then administered through your IV line. Most adults receive moderate (conscious) sedation, which makes you drowsy and relaxed while remaining able to follow simple instructions. You may feel sleepy and may not remember the procedure afterward. Children and some adults requiring rigid bronchoscopy receive general anesthesia and are completely asleep.

The Examination Process

Once you are adequately sedated and your throat is numb, the physician gently inserts the bronchoscope through your nostril (or mouth, depending on the approach) and advances it through your throat into your trachea (windpipe). You will continue to breathe normally around the bronchoscope—it does not block your airway.

As the bronchoscope moves through your airways, the camera transmits images to a video monitor. The physician systematically examines your trachea and each branching bronchus, looking for abnormalities such as tumors, inflammation, bleeding, or structural problems. The thin diameter of flexible bronchoscopes allows visualization of airways down to the fourth or fifth level of branching.

If abnormalities are identified, the physician may perform additional procedures through the bronchoscope's working channel. These include taking tissue samples (biopsies) using tiny forceps or brushes, washing the airways with saline solution (bronchoalveolar lavage) to collect cells, or suctioning secretions for microbiological analysis. You may feel brief pressure during these sampling procedures.

Completion and Initial Recovery

Once the examination and any sampling procedures are complete, the physician withdraws the bronchoscope. The entire procedure typically takes 20-30 minutes, though more complex cases requiring multiple biopsies or therapeutic interventions may take longer.

You are then moved to a recovery area where nurses monitor you as the sedation wears off. Your oxygen levels, heart rate, and blood pressure continue to be checked regularly. Most patients feel drowsy for 1-2 hours after the procedure and may not remember the examination clearly.

What Should You Expect After Bronchoscopy?

After bronchoscopy, you will rest in a recovery area for 2-3 hours until the sedation and local anesthesia wear off. Avoid eating or drinking until your gag reflex returns. Common temporary effects include sore throat, hoarseness, and coughing up blood-tinged mucus for 1-2 days. You cannot drive, so arrange transportation home.

The recovery period after bronchoscopy is usually straightforward for most patients. Understanding what to expect helps you plan appropriately and recognize when symptoms are normal versus when you should seek medical attention.

Immediately after the procedure, you will remain in the recovery area under nursing supervision. The sedation gradually wears off over 1-2 hours, during which you may feel groggy, confused, or have gaps in your memory. These effects are temporary and normal consequences of the sedation medications.

The First Few Hours

The local anesthesia in your throat takes 1-2 hours to wear off completely. During this time, your swallowing reflexes are impaired, which means you could accidentally aspirate (inhale) food or liquids into your lungs. For this reason, you must not eat or drink anything until the medical staff confirms that your gag reflex has returned.

To test whether your gag reflex has returned, the nurse may ask you to swallow a small sip of water while sitting upright. If you can swallow without coughing or choking, you can gradually resume eating, starting with small sips and soft foods. If you cough or have difficulty swallowing, you will need to wait longer before eating.

Because sedation affects alertness, reaction time, and judgment, you absolutely cannot drive yourself home after bronchoscopy. Even if you feel alert, the medications can impair your abilities in ways you may not notice. Arrange for a family member, friend, or taxi service to transport you home. Most facilities will not discharge you unless a responsible adult is present to accompany you.

Common Temporary Symptoms

Several temporary symptoms are normal after bronchoscopy and typically resolve within 24-48 hours. Knowing what to expect can prevent unnecessary worry while helping you recognize symptoms that warrant medical attention.

• Sore throat: Mild throat discomfort is common due to the passage of the bronchoscope. Warm liquids, throat lozenges, and over-the-counter pain relievers usually provide relief
• Hoarseness: Your voice may be hoarse or scratchy for a day or two after the procedure
• Blood-tinged mucus: If biopsies were taken, you may cough up small amounts of blood or blood-streaked sputum. This is expected and usually resolves within 24 hours
• Mild cough: Some coughing is normal as your airways recover from the examination
• Fatigue: You may feel tired for the remainder of the day due to the sedation

When to Seek Medical Attention

While most bronchoscopies are uncomplicated, certain symptoms after the procedure require prompt medical evaluation. Contact your healthcare provider or seek emergency care if you experience any of the following:

What Are the Risks of Bronchoscopy?

Bronchoscopy is generally safe with a complication rate of less than 1% for diagnostic procedures. Common minor effects include sore throat and blood-tinged mucus. Rare but serious complications include bleeding, infection, pneumothorax (collapsed lung), and reactions to sedation. Risks are higher when biopsies are performed.

Like all medical procedures, bronchoscopy carries some risks. However, it is considered a safe examination when performed by experienced physicians, and serious complications are uncommon. The benefits of obtaining an accurate diagnosis typically outweigh the potential risks for patients who need this procedure.

Before your bronchoscopy, your physician will discuss the specific risks relevant to your situation. Factors that may increase risk include underlying lung disease, bleeding disorders, use of blood-thinning medications, and whether biopsies or therapeutic interventions are planned.

Minor Complications

Minor complications are relatively common but resolve on their own without lasting effects. Sore throat and hoarseness occur frequently because the bronchoscope passes through the throat and vocal cord area. These symptoms typically improve within 1-2 days with simple measures like warm drinks and rest.

Temporary oxygen desaturation (low blood oxygen levels) may occur during the procedure, particularly in patients with pre-existing lung disease. This is why oxygen levels are continuously monitored, and supplemental oxygen is readily available. The medical team adjusts oxygen delivery as needed to maintain safe levels.

Serious Complications

Serious complications are rare but can occur. Bleeding is the most common significant complication, particularly after biopsies. While mild bleeding (blood-tinged sputum) is expected, significant hemorrhage requiring intervention occurs in less than 1% of diagnostic bronchoscopies. Patients on blood thinners or with abnormal clotting have higher bleeding risk.

Pneumothorax (collapsed lung) can occur when biopsies are taken through the bronchial wall (transbronchial biopsies). The reported incidence is approximately 1-4% for transbronchial procedures. Symptoms include sudden chest pain and shortness of breath. Most cases are small and resolve on their own, though some require drainage with a chest tube.

• Infection: Fever and pneumonia can develop in rare cases, particularly in immunocompromised patients
• Bronchospasm: Narrowing of the airways during the procedure, more common in patients with asthma
• Laryngospasm: Spasm of the vocal cords, which can temporarily affect breathing
• Sedation reactions: Adverse effects from sedation medications, including respiratory depression
• Cardiac arrhythmias: Irregular heartbeats during the procedure, usually temporary

When Will You Receive Your Results?

Preliminary results about what the doctor observed during bronchoscopy are usually available immediately after the procedure. However, if tissue samples (biopsies) were taken, pathology results typically take 3-7 business days. Cultures for infection may take even longer, depending on what organisms are being tested.

The timeline for receiving bronchoscopy results depends on what was found during the procedure and what types of samples were collected. Understanding this timeline helps you know when to expect information and when to follow up with your physician.

Immediately after your procedure, once you are awake enough to understand, the physician can share preliminary observations about the appearance of your airways. They can describe whether the airways looked normal, whether there were any visible abnormalities such as tumors, inflammation, or secretions, and what samples were collected for further analysis.

Pathology and Laboratory Results

If tissue samples were obtained, these are sent to the pathology laboratory where specialists examine them under the microscope. Standard pathology results for biopsies typically take 3-7 business days. More complex analyses, such as special staining for certain diseases or molecular testing for cancer markers, may take 1-2 weeks.

Samples sent for microbiological analysis (to look for infections) have variable turnaround times. Routine bacterial cultures may show results within 2-3 days, while cultures for tuberculosis or fungi can take several weeks because these organisms grow slowly in the laboratory. Your physician will inform you about the expected timeline based on which tests were ordered.

Following Up on Results

Your physician will contact you to discuss results once they are available, or you may have a scheduled follow-up appointment. Do not hesitate to call if you have not heard back within the expected timeframe. Understanding your results is an important part of your care, and you should have the opportunity to ask questions about their meaning and implications for your treatment.

Frequently Asked Questions